Approach to the patient with cholestasis and jaundice syndrome. Joint AMH, AMG, and AMEG scientific position statement.

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

The Mexican consensus on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy. / Consenso mexicano sobre diagnóstico, prevención y tratamiento de la gastropatía y enteropatía por antiinflamatorios no esteroideos.

More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. The risk factors for gastroduodenal complications due to NSAIDs are: a history of peptic ulcer, age above 65 years, high doses of NSAIDs, Helicobacter pylori infection, and the presence of severe comorbidities. The symptoms and gastroduodenal damage induced by NSAIDs vary, ranging from an asymptomatic course to the presentation of iron-deficiency anemia, bleeding, stricture, and perforation. Capsule endoscopy and enteroscopy are direct diagnostic methods in NSAID enteropathy. Regarding prevention, the minimum dose of an NSAID needed to achieve the desired effect, administered for the shortest period of time, is the recommendation. Finally, proton pump inhibitors are the gold standard for the prophylaxis and treatment of gastroduodenal effects, but they are not useful in enteropathy.

The Mexican consensus on nonalcoholic fatty liver disease. / Consenso mexicano de la enfermedad por hígado graso no alcohólico.

Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak. This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease.

Efecto Hall y estudio de fotovoltaje superficial transiente (SPV) en películas delgadas de Cu3BiS3 / Hall effect and transient surface photovoltage (SPV) study of Cu3BiS3 thin films / Efeito Hall e estudo de foto voltagem superficial transiente (SPV) em películas delgadas de Cu3BiS3

Se presentan las propiedades eléctricas del compuesto Cu3BiS3 depositado por co-evaporación. Este es un nuevo compuesto que puede tener propiedades adecuadas para ser utilizado como capa absorbente en celdas solares. Las muestras fueron caracterizadas a través de medidas de efecto Hall y fotovoltaje superficial transiente (SPV). A través de medidas de efecto Hall se encontró que la concentración de portadores de carga n es del orden de 10(16) cm-3 independiente de la relación de masas de Cu/Bi. También se encontró que la movilidad de este compuesto (μ del orden de 4 cm²V -1s-1) varía de acuerdo con los mecanismos de transporte que la gobiernan en dependencia con la temperatura. A partir de las medidas de SPV se encontró alta densidad de defectos superficiales, defectos que son pasivados al superponer una capa buffer sobre el compuesto Cu3BiS3.

Here, we present the electrical properties of the compound Cu3BiS3 deposited by co-evaporation. This new compound may have the properties necessary to be used as an absorbent layer in solar cells. The samples were characterized by Hall effect and transient surface photovoltage (SPV) measurements. Using Hall effect measurements, we found that the concentration of n charge carriers is in the order of 10(16) cm³ irrespective of the Cu/Bi mass ratio. We also found that the mobility of this compound (μ in the order of 4 cm² V-1s-1) varies according to the transport mechanisms that govern it and are dependent on temperature. Based on the SPV, we found a high density of surface defects, which can be passivated by superimposing a buffer layer over the Cu3BiS3 compound.

Apresentam-se as propriedades elétricas do composto Cu3BiS3 depositado por co-evaporação. É um composto novo que pode ter as propriedades adequadas para ser utilizado como capa absorvente em células solares. As amostras foram caracterizadas através de medidas do efeito Hall e foto voltagem superficial transiente (SPV). Através de medidas do efeito Hall se encontro que a concentração de portadores de carga n é da ordem de 10(16) cm³ independentemente da relação de massas de Cu/Bi. Também se encontrou que a mobilidade des composto (μ da ordem de 4 cm²V -1s-1) varia de acordo com os mecanismos de transporte que a governam em dependência com a temperatura. Partindo das medidas de SPV se encontrou uma alta densidade de defeitos superficiais, defeitos que são passivados a sobrepor uma capa buffer sobre o composto Cu3BiS3.

[Risk factors for peptic ulcer recurrence]. / Factores de riesgo para la recurrencia de úlcera péptica.

UNLABELLED: Prevalence of peptic ulcer (PU) and risk factors associated with its recurrence are unknown among the Mexican population. OBJECTIVE: To determine clinical features and risk factors associated with peptic ulcer recurrence. MATERIAL AND METHODS: Five-year follow-up study that included 211 men and 140 women 20 years age or older. PU diagnosis was made by clinical and endoscopic criteria. Associated risk factors such as NSAIDs use, smoking, alcohol consumption, and H. pylori infection were assessed. Clinical recurrence was defined as the time between basal diagnosis and the first PU clinical drop. RESULTS: Diagnosis of duodenal ulcer (DU) and gastric ulcer (GU) was documented in 41.9 and 58.1% of subjects. Predominant risk factor for DU was smoking, and NSAID intake for GU. H. pylori were documented in 39.3%. Sixty-five years of age or older (61 and 33% for GU and DU, respectively), and three or more associated risk factors (70%) were the main associated causes for PU recurrence. PU recurrence associated with Hp was 34%. CONCLUSIONS: GU frequency was the highest and associated risk factors for its recurrence were NSAID intake, 65 years of age or older, and Hp infection.

Nucleons II: cryopreservation and metabolic activity.

The establishment of intracytoplasmatic sperm injection (ICSI) as a routine procedure in assisted fertilization has been used in the treatment of male infertility. The major technical problem that has arisen with the use of immotile sperm for ICSI has been differentiating between live and dead cells. Nucleons from human, pig, hamster, mouse, rat, and bull have been able to induce their chromatin decondensation by the action of heparin/GSH. Cryopreservation is deleterious to sperm function, killing more than 50% of the spermatozoa during the process. Nucleon cryostorage was performed at 5 and -5 degrees C and analyzed for total area (mu2), perimeter (mu), width (mu), and length (mu), using Metamorph Imaging System software. On the other hand, fluorescein diacetate (FDA) is hydrolyzed by intracellular estereases to produce fluorescein, which exhibits green fluorescence when excited by blue light. This fact is a striking result since the presence of this metabolic activity opens the possibility to select the nucleons for ICSI. In the present study, the authors decided to search for a suitable metabolic test, which might reflect the metabolism and viability of these chromatin structures. This is a simple cryostorage technique that after months of cryopreservation, allow the use of nucleons for ICSI with suitable fertilization and pregnancies rates.

Heparin and glutathione II: correlation between decondensation of bull sperm cells and its nucleons.

The correlation between the kinetics of bull sperm nuclear and nucleon decondensation induced by the action of physiological concentrations of heparin/GSH was studied. Sperm and nucleon suspensions were incubated at 37 degrees C in salt medium, at a constant concentration of either heparin or GSH and increasing concentrations of the other reagent. Even though nucleons are pretreated with DTT/CTAB, when they are incubated alone with GSH for 96 h, they remain intact, no matter which concentration is employed, and it was impossible to observe the slightest sign of nuclei decondensation. Therefore, rupture of disulfide bridges is not the main mechanism to induce nuclei decondensation and perhaps the GSH role resides in potentate the heparin effect by increasing its negative charge. Nevertheless, nucleons reach 95% of chromatin decondensation in the presence of heparin plus GSH or heparin alone. The fact that the correlation between heparin and GSH concentrations needed to induce sperm nuclei decondensation was 3- to 4-fold greater that in nucleons might be due to the complete lack of nucleon membranes. Heparin/GSH seem to induce nuclei decondensation by an ionic chromatin charge neutralization mechanism.

[Peptic ulcer with hemorrhage. An analysis of hospital discharges]. / Ulcera péptica con hemorragia. Análisis de egresos hospitalarios.

BACKGROUND: The gastric and duodenal ulcer is the most common cause of gastrointestinal bleeding in 25% of patients, and accounting annually for approximately 50-100 admissions per 100,000 population. OBJECTIVE: To determine prevalence of gastrointestinal bleeding in hospital admission, according to age and sex and identifying the risk factors. METHOD: Determined the prevalence rates of number of hospital discharges of patients with gastrointestinal bleeding for GU and DU during period 1991 to 1997. Determined the prevalence rates of peptic ulcer occurrence for age-adjusted rates, sex and seasonal variation for 1000 hospital discharges. We investigated the features of hemorrhage of the upper gastrointestinal tract, and identification of risk factors as NSAID, alcohol and tobacco. STATISTICAL ANALYSIS: Chi square and t Student. RESULTS: The annual prevalence rates were 46.6/1000 hospital discharges. There were more frequent between 6th to 8th decades, female sex and during May, June and November. The average stay of patients were 4.2 days (range 1 to 18). A total of 275 patients were found to have GU or DU with gastrointestinal bleeding, 66% were male and mean age was 57 years. The risk factors found were tobacco 52%, alcohol 40% and NSAID 44% (P < 0.05). Melena and hematemesis was found in 64% y 36% respectively. The GU (41%) was more frequent than DU (40%) (P NS). CONCLUSIONS: The annual prevalence rates were 46.6/1000 hospital discharges more frequent in males (66%) and gastric ulcer was found more frequent (41%) than DU (P NS).

[Eradication of Helicobacter pylori in peptic ulcer and chronic gastritis. A randomized clinical trial]. / Erradicación del Helicobacter pylori en úlcera péptica y gastritis crónica. Ensayo clínico aleatorio.

BACKGROUND: The Helicobacter pylori (Hp) is found in patients with gastritis and peptic ulcer approximately in up to 80 percent. The eradication rates of 80 to 90 percent are achievable with some regimens. AIMS: Evaluate two regimens for H pylori eradication in gastritis and peptic ulcer. METHODS: Patients more than 20 years old with gastritis, gastric and duodenal ulcer disease and H pylori positive entered the study. We investigated prior history of peptic ulcer and hemorrhage, NSAID's use, smoking, alcoholism and epigastric pain. Endoscopy was performed before and at the end of the 8-12 weeks treatment, biopsies were taken from the antrum for Hp histological detection. Patients were randomly assigned to receive bismuth-metronidazole-tetracycline-ranitidine or bismuth-metronidazole-amoxicillin-ranitidine during two weeks. STATISTICAL ANALYSIS: chi square and multivariate analysis. RESULTS: One hundred and eighteen patients were included in this study, 52% male and 48% female with mean age of 47 +/- 16 years. History of peptic ulcer and bleeding was present in 79% and 62% respectively. NSAID's, and tobacco use among all patients was 49%, and 30%. Epigastric pain, melena and hematemesis was present in 90%, 47% and 24% respectively. H pylori eradication treatment was successful in 70% in both regimens (pNS). Was no related to age, tobacco and alcohol for Hp eradication (pNS), and NSAID's use was inversely related to Hp eradication (p < 0.05). Persistent peptic ulcer was seen in 23%. CONCLUSIONS: Eradication treatment was successful in 70% (p NS). Peptic ulcer refractory in 23% of patients and NSAID's use was inversely related to Hp eradication (p 0.05).

[Survival analysis in cirrhotic patients]. / Análisis de supervivencia en pacientes cirróticos.

BACKGROUND: Hepatic cirrhosis (HC) is a chronic and progressive disease that, independently of its etiology, favors the presence of some complications that impair the survival of patients. AIMS: To determine the frequency, etiology, and main decompensation factors, as well as analyse survival curves in HC of a population of Durango, México. METHODS: Cirrhotic patients of both sexes from the Hospital General del IMSS in Durango were included. The etiology of cirrhosis, the factors of decompensation and the grade of portal hypertension (PHT) were determined. A 39 month follow-up was done, registering complications and cause of death. STATISTICAL ANALYSIS: Fisher's exact test, Friedman's variance analysis, Mantel-Haenzsel chi-square test and Kaplan-Meier methods were used. RESULTS: Fifty patients were studied, 30 female and 20 male. The mean age was 54.3 years old (range 32-74 years). The more frequent etiology was alcoholic in 42% patients (19 male and 2 female). Forty three patients (86%) had decompensation by ascitis; 19 (38%) had variceal bleeding, 18(36%) had encephalopathy and 16(32%) were icteric. Twenty six patients (52%) had PHT III, and 30 (60%) were Child-Pugh class B. CONCLUSIONS: Survival in the decompensated group at 19.8 months follow-up was 62% and 73% in the total group, 20% died. Statistical significance (p < 0.05) was found between PHT grade and Child-Pugh functional class; hepatic reserve correlated inversely with bleeding (p < 0.05) and encephalopathy (p < 0.05) probability. The advanced grade of PHT directly correlated with bleeding encephalopathy and mortality (p < 0.05). We did not find any association between the etiology of cirrhosis and the incidence of complications.

[Esophageal candidiasis in AIDS. Clinical, endoscopic, and histopathologic analysis of 19 cases]. / Candidiasis esofágica en SIDA. Análisis clínico, endoscópico e histopatológico en 19 casos.

From May 1988 to December 1989, fiberoptic endoscopy of the upper digestive tract was performed in 53 patients with AIDS. In 19 cases a presumptive diagnosis of candida esophagitis was made: 13 were men and six women; the median age was 38.9 years. The Kodsi grading scale was used to evaluate the extent of the fungal colonization. In five patients no symptoms were found, eight did not show oral candidiasis; dysphagia in seven cases and odynophagia in five cases were the main esophageal complaints. Eleven cases showed pan-esophagitis, but three cases showed only the distal portion involvement. Grade II lesions were observed in ten patients, and four had grades I or III. No correlation was found between the symptoms and the grade score. Direct brushing cytology of the esophageal lesions corroborated the endoscopic diagnosis. Association with other opportunistic infections were detected only in one case. Our findings corroborates the usefulness of the fiberoptic esophageal endoscopy to improve the diagnosis of AIDS-related esophageal candidiasis in patients without symptoms or oral lesions.

[Gastric polyps. Experience at the department of endoscopy of the Salvador Zubirán National Institute of Nutrition]. / Pólipos gástricos. Experiencia en el Departamento de Endoscopia del Instituto Nacional de la Nutrición Salvador Zubirán.

During 1981-1989 we seen 54 patients with gastric polyps in the Instituto Nacional de la Nutrición SZ, Endoscopy Dept., México City. We found 100 polyps among 15,974 upper endoscopy studies (0.33%), being multiple in 22 patients with an overall of 68 polyps. Females had a predominance of 2:1 with prevalence from the 5th to 8th decades. All were asymptomatic in regard to polyps. Its main locations were in antrum (46%) and corpus (39%). They measured an average of 8 mm with a range from 5 to 25. Only three adenomatous polyps shows dysplastic changes, two with moderate dysplasia and one, bigger than 20 mm, had severe dysplasia (carcinoma in situ). Histological findings were: Inflammatory (chronic gastritis) 30%, adenomatous 22%, hyperplastic 17% and hamartomatous 13%. In seven patients we seen recurrence at follow up.

[Granulomatous hepatitis secondary to ingestion of carbamazepine. Report of a case]. / Hepatitis granulomatosa secundaria a la ingestión de carbamazepina. Informe de un caso.

A 51-year-old man with epilepsy received carbamazepine during three weeks. He developed fever, jaundice, dark urine and pale stools. Laboratory data showed hepatocellular injury and cholestasis; six weeks after withdrawal of the drug these abnormalities returned to normal limits. The liver biopsy showed acute cholangitis, bile duct injury, granulomas and eosinophils in the portal areas.